Adult_Acne_spreads by zhangyun

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        ACNE
         ANSWERSA CLOSE LOOK AT ADULT ACNE.
                BY BONNIE STARING


                You’re an adult. You shouldn’t be getting acne, right?
                But the reality is that acne can occur at any time in life.
                Here’s what you need to know to understand and
                conquer this common but frustrating skin problem. ›››




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                                          WHERE ACNE HAPPENS                               “The bacteria eat a certain portion of the
                                          Pilosebaceous follicles (pores) contain          sebum and leave behind fatty acids. The
                                          a hair root, a hair shaft and a sebaceous        fatty acids cause inflammation.”
                                          gland that produces sebum, an oily sub-          NON INFLAMMATORY ACNE
                                          stance. The sebum flows into the hair            This type of acne appears on the skin as
                                          shaft, travels up to the skin’s surface and      blackheads or whiteheads (also referred
                                          works to protect the skin from infection         to as comedones) and occurs when
                                          and prevent water loss.                          sebum and dead skin cells block the fol-
                                          HOW ACNE HAPPENS                                 licle. Blackheads are open comedones
                                          Acne is a visible result of disruptions          in which the trapped sebum and cells
                                          of the biological process in the follicle.       reach the skin’s surface. In whiteheads,
                                          This disruption can be caused by many            the trapped sebum and cells are below
                                          variables, (see “The Causes” ), but there        the surface.
                                          are four contributing factors that can           INFLAMMATORY ACNE
                                          produce acne, whether on their own or            This is often triggered by the acne bac-
                                          in combination.                                  teria Propionibacterium acnes. Inflam-
                                          1. LACK OF HAIR. “Like the wick of               matory acne appears as red lesions and/
                                          a candle, the hair wicks sebum out,”             or pimples (papules and pustules). In
                                          explains Holly Sherrard, education dir-          more severe cases inflammatory acne
                                          ector of the International Dermal Insti-         appears as nodules and cysts (also
                                          tute in Toronto. “When there’s a lack of         known as cystic acne), which lie under-
                                          hair there, the sebum tends to stay in the       neath the skin.
                                          follicle.”                                       MILIA
                                          2. DEAD SKIN CELL BUILDUP. This                  Milia are small round pockets formed
                                          buildup can block pores and trap the             by dead skin cells trapped just under the
                                          sebum inside. “People with a predispos-          skin. They can be light in appearance.
                                          ition to acne can have four to five times        YOU ARE NOT ALONE
                                          as many dead skin cells building up on           25 per cent of men and 50 per cent of
                                          their skin,” says Sherrard.                      women experience an occasional facial




                                                                                                                                        MODEL PHOTOS: THINKSTOCK, ILLUSTRATIONS: ELIZABETH DISILVESTRE
                                          3. THE SEBUM FACTOR. Either sebum                acne breakout, and one-third of these
                                          is stickier and thicker than normal, or          adults experience acne on the body, usu-
                                          more sebum is being produced than the            ally on the back or chest.
                                          pore can excrete.                                   “It’s because of the many ways that
                                          4. BACTERIA. Propionibacterium acnes             acne can occur,” explains Dr. Adam J.
                                          require no oxygen to thrive. “So when            Mamelak, MD, FRCPC, DABD, of the
                                          you have a plug on the surface of the            Meridia Medical Group in Toronto. “We
                                          skin, the bacteria have a party and break        expect acne to happen to a teenager, but
                                          down the sebum,” explains Sherrard.              when you’re an adult and you’re breaking

                                                                                                OPEN
                                                                                                COMEDO
                                                                                                TRAPPED
                                                                                                SEBUM
                                                          SKIN
                                                          SURFACE                                                  CLOSED
                                                                                                                   COMEDO
                                                                                                                   TRAPPED
                                   HAIR                                                                            SEBUM
                                  SHAFT                                 BLACK HEAD
                                                                                                                      FOLLICLE
                                 HAIR
                                                                                                                    WALL THINS
                                ROOT                 SEBACEOUS GLAND
                                                     PRODUCES SEBUM/OIL
                                                                                                                                                                                                         IN
                                                     AND FEEDS IT INTO
                                                                                                                                                                                                         TI
                                                     THE SHAFT                          WHITE HEAD                  PAPULE                                                                               BA
                   NORMAL HAIR FOLLICLE                                                                                                                                                                  GR



42 elevate | march+april.11                                                                                   elevatemagazine.com
           out, it’s a different phenomenon.”            ACNE TREATMENTS
              Adult acne tends to appear not as          All experts agree that self-diagnos-
           blackheads and whiteheads, but as tiny        ing and coming up with your own acne
           papules and pustules, “the red marks          treatment may make your condition
           that don’t really result in anything,”        worse. Leave it to the professionals to
           adds Sherrard. Due to the loss of resili-     determine what’s causing your acne and
           ence in adult skin, it takes longer for the   the best method(s) of treatment.
           acne to heal.                                 PRESCRIPTION MEDICATIONS
           THE CAUSES                                    Accutane. This medication contains a
           “What people have to remember is that         vitamin A derivative called isotretinoin,
           acne is a way for the body to tell you that   which is a retinoid that reduces sebum
           something isn’t balanced,” explains Eva       production. Side effects include dryness
           Lahman, president of Exel Profession-         of the skin, eyes and mouth, stomach
           al Line Canada. “Everything from hor-         upset and light headaches. “Accutane is
           monal issues to eating habits may trigger     not as successful in treating hormonal
           acne. There is no single food that causes     acne as other methods,” says Dr. Mame-
           acne, but a poor diet is a cause.”            lak. Accutane should not be used if you
           “Adult acne is thought to be multi-fac-       are pregnant or planning to get preg-
           torial, but one of the biggest causes is      nant. Speak with your doctor about
           using anti-aging products that are too        alternatives.
           rich,” adds Toronto-based Dr. Lisa Kel-       TOPICAL RETINOIDS. These include
           lett, MD, FRCPC, DABD. If you can still       Tretinoin, Adapaline and Tazarotene,
           feel or see moisturizer on the surface of     which all work to unclog pores and clear
           your skin long after you’ve finished apply-   the skin. All three products list skin irri-
           ing it, you could be using too much or the    tation as a side-effect, which can be
           wrong type. But she also cites dehydrat-      offset by using hydrating products rec-
           ed skin as another common acne cause,         ommended by your doctor. Tazarot-
           so never skip moisturizer altogether and      ene, like Accutane, should not be taken
           always stay hydrated by drinking plenty       by women who are pregnant or trying to
           of water and cutting back on alcohol and      get pregnant.
           salty, processed foods.                       ORAL ANTIBIOTICS. These antibiotics,
              Stress is also an acne cause, whether      such as Tetracycline, reduce the amount
           due to an important upcoming event or         of acne bacteria in the skin, which
           a hectic lifestyle. “With the influence of    reduces inflammation. Before taking
           stress, women and men produce a more          any medication, always discuss any
           aggressive form of testosterone, which        other prescriptions you may be taking,
           can cause a stickier, thicker sebum,” says    or any other conditions you have, with
           Sherrard.                                     your doctor.


                                         CYST
                                            SKIN
                                         SURFACE

                                         SAC OF                       EPIDERMAL
                                         FLUIDS                       LAYER
                                           AND
                INFLAMED                  CELLS
                   TISSUE
                                                               SKIN
                  PUS                         FOLLICLE      SURFACE
                FORMS                         WALL
NFLAMED                                       RUPTURES
ISSUE
                                           BACTERIA           SKIN
 ACTERIA         PUSTLE                                   PROTEINS                           NODULE
                                           GROWS
GROWS                                                      AND PUS



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enhance | skin-care science




                                                       OBAGI CLENZIDERM™ This prescribed                 and protected,” explains Dr. Mamelak.
                                                       skin-care system includes products that           “I call it the Three Rs: reflect, restore,
                                                       contain a solubilized form of 5% ben-             rebuild. Reflect means wear sunscreen.
                                                       zoyl peroxide, which allows the medica-           Restore means use an antioxidant and
                                                       tion to get down into the follicle to clear       moisturizer. Rebuild means use prod-
                                                       out acne bacteria.                                ucts and treatments to rebuild the skin’s
                                                       HORMONAL THERAPY. Birth control                   collagen.”
                                                       pills can be used to moderate a woman’s           OTHER ACNE TREATMENTS
                                                       androgen levels, which is good news for           PEELS. A chemical peel uses a chem-
                                                       acne sufferers, because androgens can             ical solution to remove the outer layers
DOCTOR’S ORDERS:                                       trigger excessive sebum production.               of the skin to help control acne, rejuven-
The Obagi CLENZIderm™                                  Hormonal therapy is usually prescribed            ate the skin and reduce the appearance
Acne Therapeutic System                                when acne flare-ups consistently appear           of scarring. Always seek the advice of a
provides a triple threat of                            during menstruation or when other                 professional to determine the type and
acne-busting care with                                 acne treatments haven’t had the desired           strength of chemical peel that’s right
a high concentration of
                                                       effect. Hormone therapy is not recom-             for your skin. Choices range from mild
benzoyl peroxide. $142, at
                                                       mended for women who smoke, are over              peels (with alphahydroxy acids (AHAs)
dermatologist’s offices.
                                                       the age of 35 or suffer from certain med-         such as glycolic acid, lactic acid or fruit-
                                                       ical conditions such as high blood pres-          based acids) and moderate peels (with
                                                       sure or heart disease.                            trichloroacetic acid (TCA)), to strong
                                                       OVER THE COUNTER PRODUCTS                         peels (with Phenol).
                                                       “Look for products that specifically                 “Your esthetician or dermatologist
                                                       treat adult acne, not infomercial-based           should be asking you questions about
                                                       products for all ages. Adults with acne           your skin’s sensitivity, the type of prod-
                                                       have specific skin care requirements,”            ucts you use, even if you plan on trav-
                                                       advises Dr. Kellett.                              elling or have just come back from a
                      SPOT FIGHTING SYSTEM:            DERMALOGICA’S MEDIBAC CLEAN                       holiday in a dry, sunny or humid des-
                      Clinique’s Acne Solutions        ING™ ADULT ACNE KIT: Salicylic acid               tination,” says Lahman. Moderate
                      Clear Skin System promotes       exfoliates and reduces acne formation.            and strong peels are always performed
                      smooth, clear skin. $42, at      CLINIQUE ACNE SOLUTIONS CLEAR                     by dermatologists. Depending on the
                      Clinique counters.
                                                       SKIN SYSTEM: Contains salicylic acid,             patient and the type/strength of the
                                                       plus gentle moisturizers that soothe              peel, a spot test may be done to ensure its
                                                       skin.                                             effectiveness.
                                                       YOUR SKIN CARE REGIMEN                            MICRODERMABRASION. This non-
                                                       “When you treat the face as one area,             invasive exfoliation process promotes col-
                                                       that’s where mistakes start to happen,”           lagen production and, by shedding dead
                                                       says Sherrard. She strongly suggests              skin cells, allows topical acne products to
                                                       adults use acne-fighting products on              get deep into the skin. Dr. Kellett recom-
                                                       only the parts of the face and body that          mends diamond peel microdermabra-
                                                       actually have the acne to avoid excess            sion, which is a gentle, crystal-free process
                                                       dehydration.                                      that allows patients to return to their
                                                         You can also fight acne by encour-              normal activities after an appointment.
                                                       aging healthy skin. “I recommend a                LASER TREATMENTS. Unlike peels and
                                                       regimen that keeps the skin hydrated              microdermabrasion, laser treatments



                                                       ‘‘REFLECT THE THREE RS:SUNSCREEN. RESTORE MEANS
                                                         I CALL IT
                                                                   MEANS WEAR
                                                                               REFLECT, RESTORE, REBUILD.
ACNE OPTIONS: dermalogica’s mediBac clearing™             USE AN ANTIOXIDANT AND MOISTURIZER. REBUILD
adult breakout treatment kit is just for grown-ups,       MEANS USE PRODUCTS AND TREATMENTS TO REBUILD
and contains five different anti-acne products. $52,
at dermatologists and salons.
                                                          THE SKIN’S COLLAGEN.
                                                                                                 ’’
                                                                      DR. ADAM J. MAMELAK, MD, FRCPC, DABD, THE MERIDIA MEDICAL GROUP, TORONTO




44 elevate | march+april.11                                                                                                    elevatemagazine.com
allow skin-care professionals to zero-in         microdermabrasion and laser treatments
on problem areas. These treatments are           can also be used to reduce the appear-
used for both diminishing acne break-            ance of these scars. Again, have your
outs and reducing the appearance of              skin care professional determine the best
acne scars.                                      method for the type of scar you have and
PHOTODYNAMIC THERAPY WITH                        the length of time it’s been present.
LEVULAN. This non-invasive treatment             “The higher the level of scarring, the
uses a topical photosensitizing solution         more aggressive the treatment needs to
and light therapy to target specific areas       be. The more aggressive the treatment,
affected by acne. “It is very effective and      the greater the amount of downtime,”
helps control acne and sebum produc-             explains Dr. Mamelak. “Think of it as
tion,” says Dr. Kellett.                         steps up the ladder; each step higher        READY FOR RETINOL: Retinol is a vitamin A
FACIALS. Regular facials will encour-            has the capacity to increase the level of    derivative that speeds up exfoliation. Try Exel
age healthier skin and also help relax           improvement.”                                Professional Line Lotion with tea tree oil, at salons,
                                                                                              SkinCeuticals Retinol 1.0, $58, at dermatologist’s
you, which can keep stress-induced               LEVEL 1: Topical products containing
                                                                                              offices and salons, and Murad Skin Perfectng Lotion,
acne at bay. Wondering why you’ve                vitamin A derivatives or glycolic acid.
                                                                                              $37, sephora.com.
broken out after a facial? It could be           LEVEL 2: Chemical peels.
that it’s been too long—or not long              LEVEL 3: Microdermabrasion.
enough—since the last one. A change              LEVEL 4: Laser treatments/resurfacing.
in a skin-care routine, even a healthier          “An excellent treatment is the Prof-
one, may reflect on the skin for a short         ractional laser,” says Dr. Kellett. The
amount of time.                                  system is well known for its ability to be
EXTRACTIONS. Lahman urges read-                  used on all areas of the face and for most
ers not to perform their own extractions.        skin types.
“There are certain techniques to open            LEVEL 5: Soft-tissue augmentation,
and close the pores properly. Once a             which uses injectables such as collagen
pore is open, it’s susceptible to bacteria,”     or subcutaneous fat to fill in areas of
she explains. So don’t pick, poke, pop,          tissue loss, or steroid injections.
squeeze or scratch. Seriously. Don’t.            LEVEL 6: Subcision, a surgical proced-
REMOVING ACNE SCARS                              ure that breaks up the tissue compris-
Acne scars develop as a result of inflam-        ing a deep-set scar to “raise” the surface
matory acne, leaving behind either an            of the skin.
increase or decrease in tissue. Hyper-           LEVEL 7: Surgical excision involves                           PORE PERFECTION: NeoStrata’s
trophic or keloid scars are created by a         removing the scar tissue and, if neces-                       Clarifying Lotion, $29 at drugstores,
                                                                                                               and Avon clearskin professional
buildup of collagen in the skin.                 sary, skin grafting.
                                                                                                               Clear Pore Thermal Mask, $6.99 at
   Decreased-tissue scars are more               “Acne is something that people strug-
                                                                                                               avon.ca, minimize the appearance
common and include several types. Ice-           gle with their entire life,” says Dr. Mam-                    of blackheads and open pores.
pick and box car scars are named after           elak. “The ideal scenario is to stop the
their shapes and can vary in depth.              acne to prevent more scars from occur-
Rolling scars give the skin an undulat-          ring.” So while those spots or bumps
ing appearance due to the upper layer of         may not disappear overnight, you can be
skin tethering to subcutaneous tissue.           assured that—with the help of profes-
   A number of acne treatment meth-              sionals, products and treatments—your
ods such as topical retinoids, peels,            skin can enjoy a clear future. e


EVA LAHMAN URGES READERS NOT TO PERFORM THEIR
OWN EXTRACTIONS. “THERE ARE CERTAIN TECHNIQUES
TO OPEN AND CLOSE THE PORES PROPERLY. ONCE A PORE                                              TWO FOR ONE: Look for multi-purpose acne
IS OPEN, IT’S SUSCEPTIBLE TO BACTERIA,” SHE EXPLAINS.                                          fighters, like dermalogica’s Acne Blemish Duo, $45
SO DON’T PICK, POKE, POP, SQUEEZE OR SCRATCH.                                                  at Shopper’s Drug Mart, and Olay’s 2-in-1 daily facial
                                       EVA LAHMAN, PRESIDENT, EXEL PROFESSIONAL LINE CANADA    cloths for combination.oily skin, $8, at drugstores



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